While undeniably more difficult than undergraduate classes, classroom-based courses offer medical students some familiar comfort in their preclinical years. Having succeeded in college classes filled with lectures, group projects, TA sessions, and labs, preclinical medical students are generally accustomed to learning in a traditional classroom environment. But the start of clinical rotations marks an abrupt end to comfortable classroom learning and pushes students to achieve benchmark learning goals by combining independent study with in vivo experience.
Transitioning from the classroom to the wards can be both a welcome and disorienting shift after completing the preclinical curriculum, but the transition need not seem insurmountable. Here are five tips to make your entrance into your clinical clerkships smoother:
- Ensure you always have quick reference sources like UpToDate or DynaMed on hand.
While you will spend time outside the clinic preparing for your shelf exams, on duty you will be expected to learn on the fly. Shelf exam materials are useful for acquainting yourself with the bread-and-butter conditions that will be on the test, but they often will not cut it when you are faced with a real patient, a complicated history, and an uncertain treatment course. Having real-time access to current reference materials is a must when formulating your day-to-day differential diagnoses and plans. Many medical schools provide free access to these kinds of sources, so check out what is available to you before your clinical rotations begin. Also be sure to download the associated mobile apps for these sources before your first day on the wards.
- Determine what should be in your pockets.
Though bulging pockets on short white coats can look ridiculous, carrying items you know you will need for the day is an easy way to make both your job and your team’s job easier. If you are on your surgery rotation, for example, determine what kinds of bandages will be needed for dressing changes and stash them in your pockets before rounds. For neurology, keep a reflex hammer and tuning fork on hand. For pediatrics, carry stickers. Keep a small notebook and pen with you at all times to jot down items to follow up on as they arise, and snag a patient list in the morning so you can update it with the day’s developments. You can also ask your resident or intern, as well as students who have completed the rotation before you, about what supplies are most useful to keep on hand.
- Know everything about your patients.
Medical students typically carry a lighter patient load than interns and residents and thus have more time to gather patient data. When picking up a new patient, look back through the patient’s chart. What brought the patient to the hospital or clinic? What tests have already been ordered, and what were the results? What medications was the patient on before coming to the hospital or clinic, and how have those medications changed now? Know about the patient’s other medical problems and any social or family history that may impact his or her course. If you are following a hospitalized patient, know what medications and testing are ordered each day and check intermittently to see if any new results have come in. Be ready to provide accurate updates to your team at any point during the day.
- Try to answer questions, even if you do not believe you know the answer—but remember that it is okay to not know.
“Pimping,” or the practice of residents and attendings aggressively asking medical students questions on virtually any topic without notice, is the cause of much anxiety on clinical rotations. Many medical students freeze under pressure or doubt that the answer they have is worth saying. While answering incorrectly and seeming unprepared is fearsome, not answering at all may demonstrate a lack of engagement or effort. If you do not think you know the answer to a question, begin by stating what you do know about the topic and reasoning out loud toward a possible solution. You may not arrive at the right answer, but your resident or attending will be able to gauge your level of knowledge and understand your critical thinking process.
Of course, there may be times when you have no idea what a possible answer might be, and in those situations it is okay to admit not knowing. Your residents and attendings know that you are there to learn. And if you are worried about looking bad for not knowing, find comfort in the fact that in the busyness of clinical medicine, your superiors likely will not remember that you floundered on a few questions. - Sit when you can, sleep when you can, and eat when you can.
The clinical years are filled with long hours, overnight calls, and a relentless impetus to study for exams. Survival is contingent upon maintaining your steady state as best you can. You will find that missed meals become the norm, so carry snacks with you at all times.
If you have the opportunity to sit down in a free moment—especially after standing in long surgical cases—take it. Sleep in on days off. Get to bed early if you have to be at the hospital before dawn. Even though it may seem like those around you have not slept, eaten, or rested in months, remind yourself that practicing basic self-care is not weak—it is necessary. Taking care of your physical self is essential to your learning during your clinical years.
Cassie Kosarek, MD is a professional tutor with Varsity Tutors, a live learning platform that connects students with personalized instruction to accelerate academic achievement. She earned her Bachelor of Arts from Bryn Mawr College and was a member of the Class of 2021 at the Geisel School of Medicine at Dartmouth College.